# HEEERS, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sullivan Family Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215933346
- **Authorized official:** DR. HURSIE J DAVIS-SULLIVAN M.D. (OWNER AND PRESIDENT)
- **Authorized official phone:** (601) 373-2940

## Contact information

- **Practice address:** 1814 HOSPITAL DR, JACKSON, MS 39204-3410
- **Practice address phone:** (601) 373-2940
- **Practice address fax:** (601) 373-2720
- **Mailing address:** 1814 HOSPITAL DR, JACKSON, MS 39204-3410
- **Mailing address phone:** (601) 373-2940
- **Mailing address fax:** (601) 373-2720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 13888 | MS | Yes |

## Other

- **Enumeration date:** 06/23/2005
- **Last updated:** 11/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00112110 | — | MS |
| 05 | — | 08236531 | — | MS |